The Spirit Catches You and You Fall Down

{{Short description|1997 book by Anne Fadiman}} {{More citations needed|date=August 2009}} {{Infobox book | name = The Spirit Catches You and You Fall Down | image = SpiritCatchesYAYFD.jpg | author = Anne Fadiman | cover_artist = | country = United States | language = English | series = | subject = | publisher = Farrar, Straus and Giroux | release_date = 1997 and 1998 | media_type = Print (Hardback & Paperback) | pages = 352 | isbn = 978-0-374-52564-4 | oclc= 47352453 | preceded_by = | followed_by = }} '''''The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures''''' is a 1997 book by Anne Fadiman that chronicles the struggles of the Lees, a Hmong refugee family from Houaysouy, Sainyabuli province, Laos,<ref name="Fadiman103">Fadiman. "Foua and Nao Kao." ''The Spirit Catches You and You Fall Down''. Farrar, Straus and Giroux. 1997. [https://books.google.com/books?id=DUHAXXvSUeYC&pg=PA103 103]. "[...]I asked her to describe a typical day in Houaysouy, the village in the northwestern province of Sayaboury where the Lee family had lived."</ref> and their interactions with the health care system in Merced, California. In 2005, Robert Entenmann of St. Olaf College wrote that the book is "certainly the most widely read book on the Hmong experience in America."<ref name=Entenmannp1>Entenmann, Robert. "{{usurped|1=[https://web.archive.org/web/20051219074933/http://hmongstudies.org/EntenmannHSJ6.pdf The Myth of Sonom, the Hmong King]}}." () ''Hmong Studies Journal'', Volume 6, 2005. p. 1. Retrieved on July 11, 2014.</ref>

On the most basic level, the book tells the story of the family's second youngest and favored daughter, Lia Lee, who was diagnosed with a severe form of epilepsy named Lennox-Gastaut Syndrome, and the cultural conflict that obstructed her treatment.

Miscommunications about medication dosages and parental refusal to administer certain medicines due to mistrust, misunderstandings, and behavioral side effects of epilepsy treatment, along with the failure of healthcare professionals to develop greater empathy for the traditional Hmong lifestyle or to better understand Hmong culture, lead to a deterioration in Lia's condition. The contrast between the Lees' perceived spiritual explanations for Lia's condition and the American healthcare professionals' reliance on scientific reasoning forms the overarching theme of the book.

The book is written in a distinctive style, with every other chapter returning to Lia's story and the chapters in between discussing broader themes of Hmong culture, customs, and history; American involvement in and responsibility for the war in Laos; and the many problems of immigration, especially assimilation and discrimination. While particularly sympathetic to the Hmong, Fadiman presents the situation from the perspectives of both the doctors and the family. An example of medical anthropology, the book has been cited by medical journals and lecturers as an argument for greater cultural competence, and is often assigned to medical, pharmaceutical, and anthropological students in the US. In 1997, it won the National Book Critics Circle Award for General Nonfiction.<ref>[https://web.archive.org/web/20090225065707/http://www.bookcritics.org/awards/past_awards/page_2 National Book Critics Circle - past awards]</ref>

==Major characters==

'''Lia Lee''' (Romanized Popular Alphabet: '''Liab Lis''',<ref>Fadiman, Anne. "Note on Hmong Orthography, Pronunciation, and Quotations." ''The Spirit Catches You and You Fall Down''. Farrar, Straus and Giroux. 1997. [https://books.google.com/books?id=DUHAXXvSUeYC&pg=PA292 292].</ref> July 19, 1982 – August 31, 2012<ref name=Foxdead1>{{cite web|url=https://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?ref=obituaries|title=Lia Lee Dies; Life Went On Around Her, Redefining Care|date=September 14, 2012|work=The New York Times|author=Margalit Fox|accessdate=May 27, 2018}}</ref>): a Hmong child born in Merced, California in 1982. Beginning in infancy, Lia experiences severe seizures due to Lennox–Gastaut syndrome, a rare form of epilepsy.

'''Anne Fadiman''': author and narrator of ''The Spirit Catches You and You Fall Down'', writing about her experience with Lia and her family. Throughout the story, she stresses the importance of cultural competence in the doctor-patient relationship (and in the greater medical establishment).

'''Neil Ernst and Peggy Philp''': Lia’s primary care doctors at MCMC. Throughout the story, they clash with Lia's parents, whose adherence to Hmong shamanism conflicts deeply with their own beliefs about Western medicine. Despite the good intentions of Ernst, Philp, and Lia's parents, significant miscommunication and disagreement cause Lia permanent harm.

'''Foua Yang and Nao Kao Lee''': Lia’s parents who seek care for their daughter with complex medical needs, while navigating a foreign and unfamiliar medical system without language fluency and cultural familiarity

'''Jeanine Hilt''': a social worker who makes Lia her personal cause and fights on Lia’s behalf. She is presented as one of the few members of the American medical establishment willing to acknowledge Hmong tradition and tailor treatment to Lia's case.<ref>{{citation|last=Clapsaddle|first=Diane|title=The Spirit Catches You Study Guide02|url=http://thebestnotes.com/booknotes/Spirit_Catches_You_Fadiman/The_Spirit_Catches_You_Study_Guide02.html|website=TheBestNotes.com|date=20 Mar 2015|accessdate=12 Apr 2016}}</ref><ref name=fadiman/>

==Summary== [[File:Merced, Mercy General.JPG|thumb|Mercy Medical Center Merced, previously the Merced Community Medical Center; is a new building and not the previous building where Lia Lee was taken]] Lia experienced her first seizure at three months of age, but a resident at Merced Community Medical Center misdiagnosed her condition, and the hospital was unable to communicate with her parents since the hospital had no Hmong interpreters. Anne Fadiman wrote that Lia's parents did not give her medication as it was prescribed because they believed that Lia Lee's state showed a sense of spiritual giftedness, and they did not want to take that away. The American doctors did not understand the Hmong traditional remedies that the Lee family used. The doctors treating Lia Lee, Neil and Peggy Ernst, had her removed from her home when she was almost three years of age, and placed into foster care for one year, causing friction with her parents. By age 4½ Lia Lee had been admitted to hospital care 17 times and had made over 100 outpatient visits.<ref name=Foxdead2>Fox, Margalit. "Lia Lee Dies; Life Went On Around Her, Redefining Care." ''The New York Times''. September 14, 2012. [https://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?pagewanted=2&_r=0&ref=obituaries 2]. Retrieved on October 23, 2012.</ref>

The worst seizure Lia had put her on the verge of death. She went to the emergency room and Neil Ernst could not do anything. He talked to Lia's parents about transferring her to Fresno, California, because Lia would need further treatment that Ernst could not provide. Lia's parents believed their daughter was transferred because of Ernst's vacation plans.

Lia slipped into a coma after suffering from a tonic-clonic seizure in 1986 when she was four years old. Lia's doctors believed she would die, but Lia remained alive with no higher brain functions.<ref name=Foxdead2/>

==Research== {{expand section|date=July 2014}} Fadiman's sources for information about the history of the Hmong include ''Hmong: History of a People'' by Keith Quincy. She stated "Were I citing the source of each detail, Quincy's name would attach itself to nearly every sentence in the pages on the Hmong in China."<ref name=fadiman>{{citation|last=Fadiman|title=The Spirit Catches You and You Fall Down|date=September 30, 1998|isbn=9781429931113|url=http://anthropology.msu.edu/anp370-us15/files/2015/05/The-Spirit-Catches-You-and-You-Anne-Fadiman.pdf|access-date=April 12, 2016|archive-date=October 10, 2015|archive-url=https://web.archive.org/web/20151010050245/http://anthropology.msu.edu/anp370-us15/files/2015/05/The-Spirit-Catches-You-and-You-Anne-Fadiman.pdf|url-status=dead}}</ref> Fadiman's book cited the Quincy theory that the Hmong people originated from Siberia.<ref>Pfeifer, Mark E. (Hmong Cultural and Resource Center). "{{usurped|[https://web.archive.org/web/20060206231820/http://www.hmongstudies.org/PremodernHmongHistory.pdf Overview of Recent Scholarship on Premodern Hmong History]}}" (). ''Hmong Studies Journal'' at ''Hmong Studies Internet Resource Center''. Presentation at the "[http://www.hmongstudies.com/HmongWomensConference.html “Building on Hmong Women’s Assets: Past, Present, and Future” September 16-17, 2005, St. Paul/Minneapolis, MN]" ([https://web.archive.org/web/20140714150516/http://www.hmongstudies.com/HmongWomensConference.html Archive]).</ref> Robert Entenmann wrote that because of the reliance on Quincy's book, Fadiman's book propagates the idea that Sonom was a Hmong king, a concept that Entenmann says is inaccurate.<ref name=Entenmannp1/>

==Legacy== Marilyn Mochel, a nurse and clinical educator at Sutter Merced Medical Center<!--This is the hospital which treated Lia Lee!!!!--> (now Mercy Medical Center Merced), who heads the hospital's cross-cultural program, said in 1999 that "The book has allowed more dialogue. There's certainly more awareness and dialogue than before. Both sides are teachers and learners."<ref name="Jennings">Jennings, Ralph. "[http://nl.newsbank.com/nl-search/we/Archives?p_product=MS&p_theme=ms&p_action=search&p_maxdocs=200&p_topdoc=1&p_text_direct-0=0F1D5920117213F7&p_field_direct-0=document_id&p_perpage=10&p_sort=YMD_date:D&s_trackval=GooglePM MERCED HOSPITAL FILLS CULTURAL PRESCRIPTION]." ''The Modesto Bee''. Sunday March 21, 1999. B3. Retrieved on March 12, 2012.</ref>

Lia Lee lived in a persistent vegetative state for 26 years. She died in Sacramento, California, on August 31, 2012, at the age of 30.<ref name="Foxdead1"/> At that age she weighed {{convert|47|lbs|kg}} and was {{convert|4|ft|7|in|m}} tall; many people with severe brain damage have limited growth as they age.<ref name=Foxdead3>Fox, Margalit. "Lia Lee Dies; Life Went On Around Her, Redefining Care." ''The New York Times''. September 14, 2012. [https://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?pagewanted=3&ref=obituaries 3]. Retrieved on October 23, 2012.</ref> Outside of California, her death was not widely reported. Fadiman said that pneumonia was the immediate cause of death. Margalit Fox of ''The New York Times'' said that "Lia’s underlying medical issues were more complex" because she had lived in a persistent vegetative state for such a long period of time. As of 2012, most individuals in persistent vegetative states die within three to five years of the onset.<ref name=Foxdead1/>

In 2019, ''The Spirit Catches You and You Fall Down'' was ranked by ''Slate'' as one of the 50 greatest nonfiction works of the past 25 years.<ref>{{Cite web|last=Miller|first=Dan Kois, Laura|date=2019-11-18|title=The 50 Best Nonfiction Books of the Past 25 Years|url=https://slate.com/human-interest/2019/11/50-best-nonfiction-books.html|access-date=2020-12-03|website=Slate Magazine|language=en}}</ref>

==Reception== Hmong reactions to the book were mixed.<ref>{{cite journal |last1=Hickner-Johnson |first1=Corey |last2= |first2= |date=July 2016 |title=Taking Care in the Digital Realm: Hmong Story Cloths and the Poverty of Interpretation on HmongEmboridery.org |url=https://www.proquest.com/scholarly-journals/taking-care-digital-realm-hmong-story-cloths/docview/1813893179/se-2 |journal=Journal of International Women's Studies |publisher=Bridgewater State College |volume=17 |issue=4 |pages=31–48 |doi= |issn=1539-8706 |id={{ProQuest|1813893179}} |access-date=February 6, 2025}}</ref> Ralph Jennings of ''The Modesto Bee'' said "Hmong, including some among the 2,000 in Modesto, say the book typified conflicts between their culture and American institutions. But some say it didn't capture the complexity of the Hmong culture."<ref name="Jennings"/> Cheng Lee, a brother of Lia Lee, said that his father and mother liked Fadiman's book.<ref name="Jennings"/>

Anne Fadiman's essay "Hmong Odyssey", adapted from the book, was published in the March–April 1998 ''Via''. The Hmong community leaders in Fresno, California, praised the essay, saying that it was thoughtful and accurate.<ref>"[http://nl.newsbank.com/nl-search/we/Archives?p_product=FB&p_theme=fb&p_action=search&p_maxdocs=200&p_topdoc=1&p_text_direct-0=0EAE8A732D83B82C&p_field_direct-0=document_id&p_perpage=10&p_sort=YMD_date:D&s_trackval=GooglePM ESSAY VS. APOLOGY DIVIDE HMONG * FRESNO LEADERS SAY AUTOMOBILE ASSOCIATION SHOULD APOLOGIZE ONCE MORE, AND MORE DIRECTLY.]" ''Fresno Bee''. Wednesday March 4, 1998. Telegraph A1. Retrieved on March 12, 2012.</ref>

==See also== {{Portal|California|Medicine|Religion|Society}} * History of the Hmong in Merced, California

==Notes== {{More footnotes needed|date=August 2009}} <references/>

==External sources== *{{citation |last=Fadiman |first=Anne |authorlink=Anne Fadiman |year=1997 |title=The Spirit Catches You and You Fall Down |publisher=Farrar, Straus and Giroux }} - Google Books citations lead to September 30, 1998 edition published by Macmillan, {{ISBN|1429931116}}, 9781429931113. ''New England Journal of Medicine'' article 1 [http://content.nejm.org/cgi/content/extract/353/13/1316] {{Webarchive|url=https://web.archive.org/web/20061113092102/http://content.nejm.org/cgi/content/extract/353/13/1316 |date=2006-11-13 }} * Fox, Renée C., Ph.D. "Cultural Competence and the Culture of Medicine." ''New England Journal of Medicine''. 2005; 353:1316-1319. September 29, 2005. DOI: 10.1056/NEJMp058066 ''New England Journal of Medicine'' article 2 [http://content.nejm.org/cgi/content/extract/353/13/1317] {{Webarchive|url=https://web.archive.org/web/20070121024832/http://content.nejm.org/cgi/content/extract/353/13/1317 |date=2007-01-21 }} * Malina, Debra, Ph.D. "Compliance, Caricature, and Culturally Aware Care." ''New England Journal of Medicine''. 2005; 353:1317-1318. September 29, 2005. DOI: 10.1056/NEJMp058064.

==External links== *''[https://us.macmillan.com/books/9780374533403 The Spirit Catches You and You Fall Down]'' at Macmillan Publishing *"[http://www.csuchico.edu/pub/inside/archive/01_10_25/ann.html Ann Fadiman: 'Go to the Edge of Your Culture']." {{Webarchive|url=https://web.archive.org/web/20120316221101/http://www.csuchico.edu/pub/inside/archive/01_10_25/ann.html |date=2012-03-16 }} ''Inside Chico State''. Volume 32, Number 4. October 25, 2001 *Yang, Yeng. "[https://web.archive.org/web/20130626053522/http://hmongstudies.com/HSJ-v2n2_Yang.pdf Practicing Modern Medicine: "A little medicine, a little ''neeb''"]." (." ([https://web.archive.org/web/20130626053522/http://hmongstudies.com/HSJ-v2n2_Yang.pdf Archive]) ''Hmong Studies Journal''. v2n2. northern hemisphere Spring 1998. *Ernst, Neil T. and Margaret "Peggy" Philp. "[http://journals.lww.com/pidj/Citation/1987/06000/Bacterial_Tracheitis_Caused_By_Branhamella.18.aspx Bacterial Tracheitis Caused By ''Branhamella Catarrhalis'']." ''Pediatric Infectious Disease Journal''. June 1987. Volume 6, Issue 6. Page 574.<!--This journal article discusses the Lia Lee case--> *Lilly, Amy. "[https://www.sevendaysvt.com/vermont/influential-author-discusses-how-culture-clash-became-tragedy/Content?oid=2139483 Influential Author Discusses How Culture Clash Became Tragedy]." ''Seven Days''. February 17, 2010. *Lammert, Kathy. "[https://www.epilepsy.com/article/2014/3/when-epilepsy-goes-another-name When Epilepsy Goes By Another Name]." Epilepsy.com. September 15, 2003. *Chrismer, Ellen. "[https://web.archive.org/web/20110314210516/http://dateline.ucdavis.edu/120602/dl_bookcampus.html Fadiman visit stirs emotions, understanding]." University of California-Davis. December 6, 2002. *Chiu, Monica (University of New Hampshire). "[https://web.archive.org/web/20160304070050/http://hmongstudies.com/MonicaChiuHSJ5.pdf Medical, Racist, and Colonial Constructions of Power: Creating the Asian American Patient and the Cultural Citizen in Anne Fadiman’s ''The Spirit Catches You and You Fall Down'']" ([https://web.archive.org/web/20160304070050/http://hmongstudies.com/MonicaChiuHSJ5.pdf Archive]). ''Hmong Studies Journal'' 2004-05, Volume 5. {{Merced, California}}

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{{DEFAULTSORT:Spirit Catches You, The}} Category:1997 non-fiction books Category:Works about epilepsy Category:Hmong-American culture in California Category:Hmong-American culture and history Category:Medical anthropology Category:Anthropology books Category:Anthropology of religion Category:National Book Critics Circle Award–winning works Category:Books about spirituality Category:Books about California Category:Merced, California Category:Books about Hmong people